内侧髌股韧带重建的股骨侧骨道预定位  

Pre-positioning of femoral tunnel for reconstruction of medial patellofemoral ligament

作　　者：黄勇 苏帆[1,2] 陈斐 杨远 谢环宇 孙一嘉 傅子财 谢都 陈康 冯文哲[1,2] 邓祯翰 陆伟[1,2] 朱伟民 HUANG Yong;SU Fan;CHEN Fei;YANG Yuan;XIE Huan-yu;SUN Yi-jia;FU Zi-cai;XIE Du;CHEN Kang;FENG Wen-zhe;DENG Zhen-han;LU Wei;ZHU Wei-min(Department of Sports Medicine,The First Affiliated Hospital of Shenzhen University(Shenzhen Second People's Hospital),Shenzhen 518035,China;Shenzhen Sports Medicine Engineering Center,Shenzhen 518000,China;Department of Clinical Medicine,Medical School,Shenzhen University,Shenzhen 518071,China)

机构地区：[1]深圳大学第一附属医院(深圳市第二人民医院)运动医学科,广东深圳518035 [2]深圳市运动医学工程中心,广东深圳518000 [3]深圳大学医学部临床医学系,广东深圳518071

出　　处：《中国矫形外科杂志》2021年第6期540-543,共4页Orthopedic Journal of China

基　　金：国家自然科学基金面上项目(编号:81672234);深圳市科技计划项目(编号:GJHZ20180416164801042,JCYJ20180305124912336);深圳市工业和信息化局项目(编号:201806081524201510);深圳市第二人民医院临床研究项目(编号:20173357201814)。

摘　　要：[目的]介绍内侧髌股韧带(medial patellofemoral ligament, MPFL)重建的股骨侧骨道预定位治疗复发性髌骨脱位的手术技术和初步临床结果。[方法] 2018年1月~2019年6月对36例复发性髌骨脱位患者进行MPFL重建术前预定位股骨侧骨道。术前行膝关节侧位X线片和CT平扫检查时,于膝关节内侧内收肌结节附近及髌骨内侧缘固定2枚钢珠。取股骨内侧髁与内收肌结节中点为MPFL股骨侧止点,通过测量两钢珠及连线与MPFL股骨侧止点的位置关系,在患者皮肤上标记出MPFL预定位点。于预定位点取关节镜入路,在关节镜下进行MPFL重建。[结果]全部病例获得随访,未发现再次髌骨脱位。与术前相比,末次随访时Lysholm评分和Kujala评分均显著增加(P<0.05)。影像方面,术后骨道位置与术前规划骨道一致,末次随访时膝关节Caton指数与术前相比差异无统计学意义(P>0.05),但是,末次随访时髌骨倾斜角较术前显著减少(P<0.05)。[结论]通过术前预定位MPFL股骨侧骨道,在关节镜下重建MPFL治疗复发性髌骨脱位疗效可靠,并且可以避免术中使用C型臂透视带来的电离辐射。[Objective] To introduce the surgical technique and preliminary clinical results of the prepositioning of the femoral tunnel for reconstruction of the medial patellofemoral ligament(MPFL) in the treatment of recurrent patellar dislocation. [Methods] From January2018 to June 2019, 36 patients underwent MPFL reconstruction with pre-position of the femoral tunnel for recurrent patellar dislocation.Before operation lateral X-ray and CT scanning of the knee were obtained with two steel balls fixed near the medial adductor tuberosity and the medial edge of the patella respectively. The midpoint of the medial femoral condyle and the adductor tuberosity was taken as the MPFL insertion point. By measuring the positional relationship between the two steel balls and the connecting line and the MPFL femoral insertion, the predetermined MPFL site was marked on the patient’s skin. An arthroscopic port was made at a predetermined site, and MPFL reconstruction was performed under arthroscopy. [Results] All patients were followed up, and no patellar re-dislocation occurred in anyone of them during the follow-up. Compared with those preoperatively, both Lysholm and Kujala scores increased significantly at the last followup(P<0.05). In terms of imaging, the position of the postoperative femoral tunnel proved consistent with the that planned preoperatively. Although there was no statistically significant difference in the knee Caton index measured at the last follow-up compared with that before the operation(P>0.05), the patella tilt angle at the last follow-up was significantly less than that before the operation(P<0.05). [Conclusion]By pre-positioning the femoral tunnel of MPFL before operation, the reconstruction of MPFL under arthroscopy is effective in treating recurrent patellar dislocation, and it can avoid the ionizing radiation caused by C-arm fluoroscopy during the operation.

关 键 词：复发性髌骨脱位 内侧髌股韧带 股骨骨道 关节镜 

分 类 号：R687[医药卫生—骨科学]